The Intestinal Barrier Function and Intra-Abdominal Pressure Depend on Postoperative Analgesia Technique in Children with Appendicular Peritonitis
Introduction. Peritonitis is one of the risk factors for the development of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). The plasma citrulline and intestinal fatty acid-binding protein (I-FABP) are informative markers of intestinal barrier function. The aim of this st...
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Wiley
2021-01-01
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| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2021/6650361 |
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| author | Valentyna Perova-Sharonova Ulbolhan Fesenko |
| author_facet | Valentyna Perova-Sharonova Ulbolhan Fesenko |
| author_sort | Valentyna Perova-Sharonova |
| collection | DOAJ |
| description | Introduction. Peritonitis is one of the risk factors for the development of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). The plasma citrulline and intestinal fatty acid-binding protein (I-FABP) are informative markers of intestinal barrier function. The aim of this study was to determine the correlation of the plasma citrulline and I-FABP with intra-abdominal pressure (IAP) and their relation to analgesia techniques in children suffering from appendicular peritonitis. Materials and Methods. 74 children operated for appendicular peritonitis were randomized into three groups of postoperative analgesia: “Opioids” (n = 25), intravenous morphine of 10 mcg/kg/h; “Lidocaine” (n = 23), intravenous lidocaine with initial bolus of 1.5 mg/kg and then infusion of 1.5 mg/kg/h; and “EA” (n = 26), epidurally 0.25% bupivacaine with initial bolus of 1 mg/kg and then infusion of 0.4 mg/kg/year. Retrospectively patients in each group were divided into the following subgroups: “without IAH” (n = 33), “IAH” (n = 27), and “ACS” (n = 14). We detected citrulline and I-FABP in plasma on day 1 (D1) and day 3 (D3) of hospital stay. Results. The patients without IAH on D1 presented significantly higher plasma citrulline (23.7 (16.0–31.3) nmol/ml) and lower I-FABP (76.9 (32.6–121.1) pg/ml) levels compared with patients in subgroup “IAH” (9.3 (7.3–11.3) nmol/ml and 226.0 (161.8–290.3) pg/ml, respectively) and subgroup “ACS” (6.9 (5.3–8.6) nmol/ml and 1011.7 (731.9–1291.5) pg/ml, respectively). The IAP had strong inverse correlation (rs = −0.74; p<0.00001) with citrulline and positive strong correlation (rs = 0.73; p<0.00001) with I-FABP. The citrulline in patients with IAH during three days postoperatively increased significantly in “Lidocaine” to 72% (p=0.01) and in “EA” to 138% (p=0.02), but it decreased to 13% (p=0.37) in “Opioids” group. In children with ACS, citrulline on D3 was significantly higher than that on D1 and increased in “Lidocaine” to 59% (p=0.05) and in “EA” to 134% (p=0.001), but in “Opioids” it decreased to 30% (p=0.48). The I-FABP in patients with IAH decreased to 12% in “Lidocaine” group (p=0.86) and to 75% in “EA” group (p=0.01), but it increased to 37% (p=0.57) in “Opioids” group. During observation period, I-FABP in patients with ACS decreased significantly in “Lidocaine” to 42% (p=0.05) and in “EA” to 96% (p=0.003), but it increased in “Opioids” to 63% (p=0.22). Conclusions. The IAP was inversely correlated with plasma citrulline and positively correlated with I-FABP in children with appendicular peritonitis. Epidural analgesia is the most protective for intestinal wall barrier function in patients at risk of IAH and ACS. |
| format | Article |
| id | doaj-art-487a5ffbb69c47bb95db42ad8044212b |
| institution | OA Journals |
| issn | 2090-1305 2090-1313 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Critical Care Research and Practice |
| spelling | doaj-art-487a5ffbb69c47bb95db42ad8044212b2025-08-20T02:38:01ZengWileyCritical Care Research and Practice2090-13052090-13132021-01-01202110.1155/2021/66503616650361The Intestinal Barrier Function and Intra-Abdominal Pressure Depend on Postoperative Analgesia Technique in Children with Appendicular PeritonitisValentyna Perova-Sharonova0Ulbolhan Fesenko1Department of Anaesthesiology and Intensive Care, Lviv Regional Pediatric Hospital, Lviv 79000, UkraineDepartment of Anaesthesiology and Intensive Care, Danylo Halytsky Lviv National Medical University, Lviv 79010, UkraineIntroduction. Peritonitis is one of the risk factors for the development of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). The plasma citrulline and intestinal fatty acid-binding protein (I-FABP) are informative markers of intestinal barrier function. The aim of this study was to determine the correlation of the plasma citrulline and I-FABP with intra-abdominal pressure (IAP) and their relation to analgesia techniques in children suffering from appendicular peritonitis. Materials and Methods. 74 children operated for appendicular peritonitis were randomized into three groups of postoperative analgesia: “Opioids” (n = 25), intravenous morphine of 10 mcg/kg/h; “Lidocaine” (n = 23), intravenous lidocaine with initial bolus of 1.5 mg/kg and then infusion of 1.5 mg/kg/h; and “EA” (n = 26), epidurally 0.25% bupivacaine with initial bolus of 1 mg/kg and then infusion of 0.4 mg/kg/year. Retrospectively patients in each group were divided into the following subgroups: “without IAH” (n = 33), “IAH” (n = 27), and “ACS” (n = 14). We detected citrulline and I-FABP in plasma on day 1 (D1) and day 3 (D3) of hospital stay. Results. The patients without IAH on D1 presented significantly higher plasma citrulline (23.7 (16.0–31.3) nmol/ml) and lower I-FABP (76.9 (32.6–121.1) pg/ml) levels compared with patients in subgroup “IAH” (9.3 (7.3–11.3) nmol/ml and 226.0 (161.8–290.3) pg/ml, respectively) and subgroup “ACS” (6.9 (5.3–8.6) nmol/ml and 1011.7 (731.9–1291.5) pg/ml, respectively). The IAP had strong inverse correlation (rs = −0.74; p<0.00001) with citrulline and positive strong correlation (rs = 0.73; p<0.00001) with I-FABP. The citrulline in patients with IAH during three days postoperatively increased significantly in “Lidocaine” to 72% (p=0.01) and in “EA” to 138% (p=0.02), but it decreased to 13% (p=0.37) in “Opioids” group. In children with ACS, citrulline on D3 was significantly higher than that on D1 and increased in “Lidocaine” to 59% (p=0.05) and in “EA” to 134% (p=0.001), but in “Opioids” it decreased to 30% (p=0.48). The I-FABP in patients with IAH decreased to 12% in “Lidocaine” group (p=0.86) and to 75% in “EA” group (p=0.01), but it increased to 37% (p=0.57) in “Opioids” group. During observation period, I-FABP in patients with ACS decreased significantly in “Lidocaine” to 42% (p=0.05) and in “EA” to 96% (p=0.003), but it increased in “Opioids” to 63% (p=0.22). Conclusions. The IAP was inversely correlated with plasma citrulline and positively correlated with I-FABP in children with appendicular peritonitis. Epidural analgesia is the most protective for intestinal wall barrier function in patients at risk of IAH and ACS.http://dx.doi.org/10.1155/2021/6650361 |
| spellingShingle | Valentyna Perova-Sharonova Ulbolhan Fesenko The Intestinal Barrier Function and Intra-Abdominal Pressure Depend on Postoperative Analgesia Technique in Children with Appendicular Peritonitis Critical Care Research and Practice |
| title | The Intestinal Barrier Function and Intra-Abdominal Pressure Depend on Postoperative Analgesia Technique in Children with Appendicular Peritonitis |
| title_full | The Intestinal Barrier Function and Intra-Abdominal Pressure Depend on Postoperative Analgesia Technique in Children with Appendicular Peritonitis |
| title_fullStr | The Intestinal Barrier Function and Intra-Abdominal Pressure Depend on Postoperative Analgesia Technique in Children with Appendicular Peritonitis |
| title_full_unstemmed | The Intestinal Barrier Function and Intra-Abdominal Pressure Depend on Postoperative Analgesia Technique in Children with Appendicular Peritonitis |
| title_short | The Intestinal Barrier Function and Intra-Abdominal Pressure Depend on Postoperative Analgesia Technique in Children with Appendicular Peritonitis |
| title_sort | intestinal barrier function and intra abdominal pressure depend on postoperative analgesia technique in children with appendicular peritonitis |
| url | http://dx.doi.org/10.1155/2021/6650361 |
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